Provider Demographics
NPI:1407410459
Name:RUSH, LETEA
Entity Type:Individual
Prefix:
First Name:LETEA
Middle Name:
Last Name:RUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6012 COUNTY FARM ROAD
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-2251
Mailing Address - Country:US
Mailing Address - Phone:518-584-7460
Mailing Address - Fax:518-583-1202
Practice Address - Street 1:6012 COUNTY FARM ROAD
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-2251
Practice Address - Country:US
Practice Address - Phone:518-584-7460
Practice Address - Fax:518-583-1202
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator